Provider Demographics
NPI:1962670513
Name:GRAHAM, WAN CHEN K (MA, OTR/L)
Entity Type:Individual
Prefix:
First Name:WAN CHEN
Middle Name:K
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:CONVERSE 7
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120
Mailing Address - Country:US
Mailing Address - Phone:617-754-5662
Mailing Address - Fax:617-754-6636
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:CONVERSE 7
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:617-754-5662
Practice Address - Fax:617-754-6636
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA7996225X00000X
MA9516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist